In Limerick, which may stand for a typically unhealthy Irish city in the worst period of over-population, there were many more deaths from smallpox among children than from measles, the age-incidence being nearly the same, according to the following dispensary statistics for a number of years before 1840[1225]:

Limerick Dispensary Deaths.

Age 0-5 5-10 10-15 15-20 Total
Smallpox 333 55 5 0 393
Measles 187 32 6 1 226
Scarlatina 8 2 10

Although it is impossible to prove it, yet the indications all point to measles having kept for a whole generation after 1808 the leading place among infantile causes of death which it then for the first time definitely took[1226]. Almost the only direct references to the subject were made by way of controverting the doctrine of Watt; but these are too meagre, or too general in their terms, to be of any use[1227]. The epidemics of measles seem to have travelled then, as they do now, from county to county in successive years. Thus in 1818, while most parts of England were or had recently been suffering from smallpox, the Eastern counties were suffering from measles “very frequent and fatal.” Smallpox at length reached Norwich in 1819, and became the reigning epidemic in the place of measles, which was “hardly met with” so long as the enormous mortality of the other disease proceeded[1228]. At Exeter in the spring of 1824 measles became epidemic after a long interval; many susceptible children had accumulated, and of these few escaped. The mortality was very great, and was caused by severe pulmonary inflammation, the catarrhal symptoms being mild. In one day seventeen children were buried in one of the five parish churchyards of the city; but that high mortality, according to the parochial surgeon, did not on an average stand for more than four deaths in one hundred cases[1229].

When the curtain rises, in the summer of 1837, upon the prevalence and distribution of diseases in England, as ascertained by the new system of registration of the causes of death, measles is found in the first place among the infectious maladies of childhood, thereafter yielding its place to smallpox for a year or more, and taking the lead again until it was passed by scarlatina.

Deaths by Measles and Smallpox in London, 1837-39.

1837 1838 1839
3rd Qr. 4th Qr. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. (four quarters)
Measles 822 532 173 96 94 225 2036
Smallpox 257 506 753 1145 1061 858 634

The epidemic of smallpox hardly touched the Eastern counties until 1839; so that while the home counties in that year had far more deaths by measles than by smallpox, Norfolk had only 72 deaths by the former against 820 deaths by the latter. In the same year measles took the lead in four out of six great English towns, scarlatina being the dominant infection in one (Sheffield), and smallpox in one (Bradford):

Deaths in 1839 by the three chief infections of Childhood.

Liverpool Manchester Leeds Birmingham Sheffield Bradford
Measles 401 773 383 170 33 70
Scarlatina 374 264 35 133 419 7
Smallpox 259 237 171 56 16 208